中危肺栓塞溶栓与抗凝治疗选择的回顾性分析

Retrospective Analysis of the Choice of Thrombolysis and Anticoagulant Therapy for Intermedi-ate-risk Pulmonary Embolism

【目的】探讨中危肺栓塞采用溶栓或抗凝两种治疗方案的优劣。【方法】对既往肺栓塞患者中符合中危标准共66例患者，以曾接受的治疗分为溶栓组与抗凝组，通过记录两组治疗前和治疗后24～48h的心动超声指标、心肌损伤标志物以及28d病死率，比较两组之间的治疗效果是否存在差异。【结果】溶栓组在治疗前后心动超声右心室功能改善的差异有统计学意义（P〈0．05），两组心肌损伤指标以及d28病死率的差异未发现统计学意义（P〉0．05）。【结论】溶栓治疗与抗凝治疗在降低中危肺栓塞早期病死率方面并无明显差异，中危肺栓塞患者采取溶栓治疗仍需谨慎。

[Objective] To explore the advantage and disadvantage of thrombolysis and anticoagulant therapy for intermediate-risk pulmonary embolism. [Methods] A total of 66 patients with intermediate-risk pulmonary embolism who were treated with thrombolysis or anticoagulation in the past were divided into thrombolysis group and anticoagu- lation group. Echocardiographic indexes, the markers of myocardial injury and the mortality rate on day 28 before and 24~48h after treatment were recorded. The efficacy was compared between two groups. [Results] There was signif- icant difference in the improvement of echocardiographic right ventrieular function in thrombolysis group between be- fore and after treatment（ P 〈0.05）. There was no significant difference in the markers of myocardial injury and the mortality rate on day 28 between two groups（ P 〉0.05）. [Conclusion] There was no obvious difference in decrea- sing the early mortality rate of intermediate-risk pulmonary embolism between thrombolysis and anticoagulation. Thrombolysis should be used for intermediate-risk pulmonary embolism.